Blacks Less Likely to Get Bone Marrow Transplants

Action Points

Note that blacks are less likely than whites to receive bone marrow transplants.

Note, too, that women are less likely than men to receive bone marrow transplants.

African Americans are less likely than whites to receive hematopoietic stem cell transplants (HCT) -- an expensive procedure that can greatly increase survival for cancers of the blood, a new study found.

Overall, Caucasians were 40% more likely to undergo HCT to treat leukemia, lymphoma, or multiple myeloma than African Americans (OR 1.40; 95% 95% CI 1.34 to 1.46), according to the report published online May 24 in the journal Cancer.

"Importantly, lower HCT rates for blacks were noted for autologous HCT [in which a patient receives a transplant of their own previously collected tissue], indicating that donor availability cannot fully explain the differences observed," Thomas V. Joshua, MS, of the Medical College of Georgia, and colleagues wrote.

Although less striking, the researchers also found a gender disparity in HCT treatment. Overall, men were 7% more likely than women to receive HCT (OR 1.07; 95% CI 1.05 to 1.1; P<.0001), but this difference was only significant for autologous HCT (OR 1.10; 95% CI, 1.07 to 1.13; P<.0001).

In HCT procedures, commonly called bone marrow transplants, donor stem cells are transplanted into a recipient to restore hematopoiesis after irradiation. Use of the procedure has grown rapidly over the past few decades with approximately 60,000 transplants taking place worldwide in 2006. HCT is a key treatment option for patients with leukemia, lymphoma, and related disorders and can offer the best chance for survival.

However, disparities based on race and gender in who receives certain types of medical procedures are common and well documented. Based on evidence for disparities in other areas of medicine, Joshua and colleagues hypothesized that women and African Americans with leukemia, lymphoma, or multiple myeloma were less likely to receive HCT.

The researchers estimated the annual incidence of these diseases in the U.S. among people younger than 70 by race and sex using the Surveillance, Epidemiology, and End Results (SEER) database, a national cancer registry that recorded cases from between 1997 and 2002, and data from U.S. census reports for 2000.

The authors then estimated the number of HCT procedures (autologous, human leukocyte antigen, identical sibling, and unrelated donor) performed from 1997 through 2002 based on data from the Center for International Blood and Marrow Transplant Research. Comparing these two sets of data, they estimated the rates of HCT based on race and sex.

"The findings of the current study suggest a disparity in the rates of autologous and allogeneic HCT for African Americans and females that should cause concern, with the greatest disparity observed based on race," the authors wrote.

They speculated possible reasons for the difference in HCT rates could include underutilization in African Americans or overutilization in Caucasians, biological differences (e.g., greater distribution of HLA types in blacks), or fewer numbers of black donors in bone marrow registries. Whatever the reasons, the study suggests that African Americans who should be receiving HCT are not. The reasons for the disparity between men and women were less clear, the authors wrote.

The researchers noted several limitations of their study. While comparisons of HCT procedure rates in different regions might reveal important information that could help explain the disparities, the structure of the databases prevented such an analysis.

The authors noted that the identification of patients by race was conducted by the various transplant centers, which might not have used consistent criteria for classifying patients by race. Also, the data did not included information about rates of referral for HCT, so the researchers were unable to discern whether there were race- or sex-based differences in who got referred for the treatments.

The study used data from the Center for International Blood and Marrow Transplant Research, which received funding from a number of government agencies, nonprofit organizations, and companies.

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.